9 minute read
THE EXPEDITION DOCTOR
WHAT’S IN MY BAG
THE EXPEDITION DOCTOR
WHEN HE’S NOT TRYING TO CAST A FLY, DR PATRICK AVERY CAN FREQUENTLY BE FOUND TENDING TO SIR DAVID ATTENBOROUGH AND HIS BBC FILM CREWS ALL OVER THE WORLD … FROM RAINFORESTS TO SAVANNAH, ICELAND TO ANTARCTICA. HERE’S HIS ADVICE ON THE MEDICAL KIT TO PACK FOR A PROPER EXPEDITION.
Photos Patrick Avery
Iwas lucky to be born, raised, and schooled in Kenya in the 1980s. Our family recreation time was generally spent on safaris exploring the wilderness areas of East Africa, camping, learning about African flora and fauna, hiking up hills, fishing, competing in the Rhino Charge - an extreme offroad driving event, and getting lots of experience fixing Land Rovers.
I did alright at school and, for one reason or another, I decided to apply for medical school in the UK. The culture shock from this move was immense and the graft was longer and harder than I had anticipated but, eventually, after six years of uni and a further eight years of post grad work/study I qualified as a General Practitioner. I always felt somewhat stifled by life in the UK, given the lack of wilderness and adventure. In 2010 however, I stumbled upon the discipline of wilderness/expedition medicine and due to various fortuitous circumstances this opened up a wealth of incredible travel opportunities and experiences to me.
Over the course of the last decade, alongside the extensive personal fly-fishing travel I have done, I’ve been fortunate to have worked as an expedition doc for the BBC Natural History Unit in a multitude of different environments worldwide. These include the rainforests of Costa Rica and Congo, the jungles of Burma, the harsh wintery wastes of Iceland, Siberia, Finland and Antarctica, and the good old African bush country of Kenya, Zimbabwe and Zambia. My role on these trips is nominally to keep the team safe and to respond to any acute medical problems that may arise, as well as mucking-in with the rest of the team, taking photos, and sneaking in some fishing where time and opportunity arise.
Although my primary day job is as a GP (now based back in Kenya again), in latter years one of my most important and cherished roles has been keeping a watchful eye on Sir David Attenborough on a number of different international filming trips. A lifelong idol/hero of mine it has been a privilege to spend so much time travelling with, and getting to know the great man. I’ve been lucky.
Expedition Medical Kits: what to take
Expedition medical kits can be very large and extensive but for the purposes of this article I will focus primarily on what med kit I carry as a lightweight, bare minimum when heading to an equatorial African fly-fishing destination. These trips often necessitate meagre luggage allowances so the med kit has to be similarly whittled down.
Before you go
Always remember that prevention is better than cure. Take some travel advice before you go and research the main medical risk factors. Check whether you need any specific vaccines or antimalarials. Normally people worry overly about things like snakes/scorpions/spiders which, in reality, rarely cause you problems. The main risks are generally related to road travel accidents, heat illness, sunburn, foot/ leg injuries, skin problems, allergies, infected wounds, insect bites, and diarrhoea. Get that sensitive tooth or niggling medical problem looked at before you head off to the middle of nowhere. Toothache will ruin your trip! Pack a small travel mosquito net and get full travel insurance from a reliable provider to cover you for evacuation and take heed of FCO black lists. Consider doing an advanced wilderness first aid course so you have some skills. Take a sufficient supply of any regular meds that you take normally (tablets, inhalers etc). Pack a couple of EpiPens if you suffer from anaphylaxis and make sure those travelling with you know where you keep them and how to use them. If you are prone to regular bouts of a specific illness that requires a specific treatment, take a supply of that treatment with you just in case. Some people get constipated when they travel. If you do, take some laxatives with you. Do some fitness/training before you go. These fishing trips can physically take their toll on feet, hands, shoulders, and backs particularly when throwing a 12 weight for hours on end in the surf in places like Gabon. Some cardio and strength endurance training in the 6-8 weeks pre departure will make you more resilient. Fighting a 70kg tarpon on a fly rod is not easy. I’ve witnessed someone fighting a big fish having to walk 200 yards backwards up the beach into the adjacent rainforest, rod in hand, in order to drag a big fish ashore which they simply were incapable of winding in.
Heat illness
Heat illness is incredibly common and is made more so if people are unfit, overweight, jet-lagged, dehydrated, hung over, over-exerting themselves, or unacclimatised. One can acclimatise but this takes several weeks to do. Heat illness causes a range of symptoms from headaches and nausea, to coma, collapse, and death. Destinations like Gabon or Cameroon will often have ambient day time temperatures of close to 40 degrees C with high humidity. Simply standing on a beach/river bank in the middle of the day can give you heat illness. Being mindful of this and keeping a watchful eye on one another is critical. Anyone who starts behaving strangely/stumbling/ mumbling needs to be swiftly taken into the shade and cooled by stripping them down, pouring water on them and fanning their bare skin. They will be more prone to further heat illness in the following days and must take extreme care to avoid repeated heat injuries ideally by avoiding operating in the heat of the day. Keeping your head and skin covered from the sun’s UV rays is critical. Don’t wander around shirtless and hatless. UV-rated long sleeves/gloves/leggings are a must. The leggings also help prevent chaffing. I’ve found a small UV-rated umbrella is an essential travel item both for providing shade and rain cover.
Foot/skin care
Your skin takes a hammering on these trips. Whether it be fish spines in the hands, friction burns, sunburn, thorns, or blistered and bruised feet. When walking around in forests, flooded environments, or beaches with lots of debris there are plenty of ways to hurt your feet/legs. I’ve seen several deep lacerations to legs/ankles sustained in this manner and I’ve also very nearly walked on a Rhino Viper barefoot on a Gabonese beach. I’ve had to suture up both my own ankle and my Dad’s calf on separate trips. Whilst it is nice going bare-foot, I’ve realised from bitter experience that wading shoes are a good way to protect your feet.
Plenty of bottled/boiled water irrigated over a wound is the best way to clean it thoroughly. I also always carry a small bottle of betadine for cleaning wounds and a small suture kit with some 4/0 sutures, needles, syringe, and 5mls of 2% lidocaine anaesthetic. For those who can’t suture then some steri strips and some standard super glue work very well for closing most wounds. The glue is useful for fixing fishing tackle too. A 50 x 5 cm piece of kinesio tape cut and rolled is invaluable for cutting into strips to place over any blisters/hot spots on the feet and can also be used on fingers for friction burn prevention. A roll of zinc oxide tape and a selection of fabric plasters for small cuts are also a must.
I carry a small tube of Germolene which is a good antiseptic application for wounds and also helps soothe chaffed nether regions. Pack a couple of sterile hypodermic needles for digging out thorns or gently decompressing a blister. I always carry a Leatherman so I have a knife and scissors to use.
Insect biting activity can be horrendous on these trips. The itching drives you mad and can lead to a skin infection. Some topical steroid cream applied twice daily (15g of either hydrocortisone 1% or Eumovate) is brilliant for reducing the itch and irritation. Likewise a small tube of Eurax HC is excellent for itchy bites.
Trauma
Serious trauma, while generally rare, is a life threatening problem. I always carry the following: 1. battlefield tourniquet for staunching bleeding limbs 2. small pack of Celox quick clot for bleeding in the groin/ armpits/neck 3. large bore cannula for decompressing tension pneumothorax and IV access 4. a single trauma bandage 5. 1000mg of injectable tranexamic acid for haemorrhage control
Pain relief
Its always worth having a range of pain relief options as follows (increasing strength): 1. Paracetamol 500mg x 16 2. Ibuprofen 400mg x 12 3. Co-codamol 30/500 x 10
Antibiotics
I always carry two antibiotics: 1. Co-amoxiclav (Augmentin) 625mg x 21 to cover skin/ chest/throat/ear/sinus/urine infections (if penicillin allergic take Clarithromycin 500mg x 14 instead). 2. Azithromycin 500mg x 3 to cover traveller’s diarrhoea/chest
Allergic reactions
I don’t tend to carry an EpiPen as I don’t have allergies myself but will carry a couple of vials of 1:1000 adrenaline for use in event of anaphylaxis in a companion. I also carry: 1. Chlorphenamine 10mg injectable (antihistamine) 2. Cetirizine 10mg x 5 (antihistamine tablets) 3. Ventolin inhaler for asthma attacks/anaphylaxis 4. Prednisolone 5mg x 28 (steroid tabs for severe allergies or exacerbations of asthma. Take 6-8 at once for 3-5 days)
Other assorted items
A few other assorted essentials that I carry: 1. Omeprazole 20mg x 5 (anti reflux meds) 2. Chloramphenicol eye ointment x 4g for eye injuries/ infections 3. Buccastem 3mg x 10 (anti-vomiting tabs that dissolve in your mouth) 4. Oral rehydration salts x 5 packs 5. Nasopharyngeal airway x 1 6. Gauze swabs 7. Tweezers 8. A roll of compression bandage for binding up twisted ankles or other swollen joints. Also useful in event of snake bite where immobilisation and compression bandaging of the affected limb/bite site is recommended.
Fishing gear
Depending on where my expedition work has taken me, if there is a potential for some fishing I always try to pack an appropriate rod and reel combination for my perceived quarry. Normally this is a #6 or 7 wt travel rod. Over the years during downtime on BBC trips I’ve managed to catch mahseer in jungle rivers in Burma (where I’m convinced no one has ever thrown a fly before), giant Icelandic brown trout, and tigers in the Zambezi. If ever you are looking for an adventurous doctor to accompany you on a trip somewhere then please drop me a line. IG: @drpatrickavery
Patrick takes a dip with 80kg of Nile perch, caught below Murchison Falls, Uganda.
